The New(est) War on Cancer

In the president’s State of the Union speech, he vowed to cure cancer, likening the effort to a new moonshot. I have no doubt he’s sincere, just as he was sincere when he promised that the Affordable Care Act would reduce healthcare costs without the need to give up our doctors or insurance plans. I assume he was sincere the last time he launched a new effort to cure cancer as well. That was in 2009. By doing so, he joined with Presidents Nixon and Clinton who also launched wars on cancer.

Already, various government health agencies are talking about how they’ll spend the presumably huge amounts of money this moonshot will require. This is a safe bet because Vice-President Biden has been charged with bringing his gravitas to this effort, and he’s already helped get an extra $264 million for the National Cancer Institute. Biden has confirmed that his first step will be to increase funding for research, presumably to other public health agencies and especially the National Institutes of Health (NIH).

Secondly, he plans to spend money to encourage private companies to share data. Then, according to this article, he made plans to travel to Switzerland for the World Economic Forum “to talk with international oncology experts in an effort to accelerate research.”

Am I optimistic? Well, yes and no.

I’m optimistic that most cancers can be cured. In fact, I’m closely following the development of several companies that have discovered revolutionary approaches to treating the various forms of the disease. On the other hand, I don’t know any accomplished scientist who has real faith in the NIH.

I’m not taking shots at the people who work at the NIH, but my impression is that the most talented researchers are either running their own labs for academic institutions dedicated to licensing discoveries for significant amounts of money, or they are working on the frontlines of biotech.

If the NIH had been a little more accurate even on basic questions of nutritional science over the last several decades, I would probably have more faith in the organization now. Though there are brilliant people at the NIH, it is a quasi-political organization with all the attendant bureaucratic issues. For ambitious scientists, it’s a stop-off on the way to something more important.

Nor am I particularly impressed by Biden’s proposal to encourage private-sector scientists to share information. When I told my biologist wife about this plan, she instantly guffawed. In my experience with important biotechs and non-profit research groups, scientists are almost always protective, even secretive, about critical discoveries. Like other people, they want credit and compensation for their work, and I’ve seen scientists compete against one another to crack the same puzzle while taking care never to allow information about their work to leak. Much of what I know about emergent biotechnologies, I cannot share because of nondisclosure agreements.

I’m puzzled that some people believe data sharing would benefit anybody as much as the bureaucrats paid to administer the program. It’s almost as if the vice-president doesn’t understand or even like the private sector or individual initiative, though that’s where the vast majority of healthcare breakthroughs come from.

I’m equally puzzled by Biden’s decision to go to Switzerland to talk about cancer. There are, of course, brilliant European scientists, but I don’t believe they collectively know more about cancer research than the University of Texas MD Anderson Cancer Center, to name just one American example. Maybe the vice-president is just more comfortable in Switzerland than he is in Houston.

If the president really wanted to help accelerate the arrival of cancer cures, he would shift his attention from pure research to regulatory reform. I would suggest he read this article about Dr. Richard Pazdur, the FDA head of cancer drug approvals for over a decade and a half.

For years, Pazdur was feared by biotechs and denounced by cancer activists for his seemingly obstructionist attitudes about drug approval. That changed, however, when his own wife challenged him (through FDA channels) to approve an experimental cancer drug that might have saved her life—if she had access to it when it first appeared.

There are therapies in labs now that will change the way we view cancer forever. I’m already on record saying we are close to a day when the vast majority of cancers will represent no more of an inconvenience than the common cold.

This isn’t based on some vague confidence in the creativity of the human species. It comes from real data and long conversations with some of the most brilliant scientists in the world. Some cancers, especially early-childhood forms caused by genetic disorders, are going to be more difficult to beat, but we’ll take them out as well.

Some of the biggest cancer breakthroughs will not even come from the field of cancer research. Almost all cancers come from the malfunction of biological systems associated with aging. When true anti-aging therapeutics are allowed, most cancers will never happen. Or they will happen so close to the end of much longer lives that they won’t matter. Anti-aging therapeutics will also address the other big killers, including cardiovascular disease and Alzheimer’s.

Every time I speak publicly about the state of science and the looming cures, somebody approaches me afterward about a friend or relative who is dying. It’s heartbreaking because I have to tell them that the only thing standing between them and startlingly effective cures is traversal of the regulatory labyrinth between the labs and the clinics.

Biotech warriors will have to arm themselves with many millions of borrowed dollars to get through phase 1 trials, dropping piles of cash in the dark recesses of the maze before reaching phase 2. At that point, they will probably be forced to give up substantial ownership of their work to get even more money from some big pharma company to meet FDA requirements. In five or ten years, a drug might be approved, but only for the specific form of cancer treated in the phase 2 and 3 trials. Then, insurance companies will be allowed to pay for the treatment of that particular type of cancer.

Of course, many of you won’t believe me when I say that we have beat most cancers in the lab. That’s fine. But you should understand how radically the biological sciences have changed in recent years. Not only has more been discovered about the molecular, cellular, and genetic mechanisms associated with cancer in the last ten years than all previous history, the pace of research has accelerated. Tests that would have taken weeks or months only a decade ago can be done in minutes now. Current researchers have the benefit of tools and knowledge that make the 20th century seem almost like the Middle Ages.

Thinking about the most promising anti-cancer drugs I’m tracking, one common characteristic stands out to me: All of the core breakthroughs were accidental—discovered by curious scientists. Not one of these new technologies came into existence as a direct result of a research program aimed at curing cancer.

That is, in fact, how most science happens. Yes, of course some of the pure research has contributed to the general understanding of cancer, but I think there’s a misconception about the role of big, centralized research programs.

Coincidentally, as I was writing this, a colleague sent me the link to an article in the Wall Street Journal by Matt Ridley, titled, “The Myth of Basic Science.” It debunks the top-down model of scientific discovery. I wish the president and vice-president would read it and take it to heart.

What we need now is not more basic research, but the removal of the obstacles that are slowing scientific progress in the name of safety. We all need to learn the lesson Dr. Richard Pazdur learned, that it’s only rational and humanitarian to give people who are already dying the freedom to choose what drugs they take. And, by the way, we’re all already dying.

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